Medicare Advantage and Part D Plans Restrict Ondansetron Access
Medicare Plans restrict Access to Affordable Antiemetic, Study Finds
Millions of Americans wiht cancer face hurdles accessing a low-cost anti-nausea medication due to restrictive policies in Medicare Advantage and Part D plans, a new study reveals.
Despite ondansetron being available as a generic since 2006, researchers found that these plans frequently employ prior authorization requirements and quantity limits, perhaps delaying treatment and increasing administrative burdens for both patients and healthcare providers.
The study,published in JAMA Network open,analyzed data from over 4,300 Medicare prescription drug plans,encompassing both Part D and Medicare Advantage.Researchers examined the use of utilization management tools and costs for oral ondansetron, a commonly prescribed medication to prevent nausea and vomiting associated with chemotherapy.
Barriers to Access:
Prior Authorization: Medicare Advantage plans were significantly more likely to require prior authorization for ondansetron (90.3%) compared to Part D plans (71.9%).
Quantity Limits: Medicare Advantage plans also imposed quantity limits on ondansetron prescriptions more frequently enough (22.5%) than Part D plans (16.5%).
Cost Discrepancies:
While Medicare Advantage plans offered lower costs for 4-mg and 8-mg ondansetron tablets compared to Part D plans, both plan types charged significantly more than the Mark Cuban Cost Plus Drug Company, a direct-to-consumer pharmacy known for its transparent pricing.
Such as, a 30-day supply of 4-mg ondansetron tablets cost $24.40 in Medicare Advantage plans and $31.40 in Part D plans, compared to just $9.50 through the Cost Plus drug Company.
Call for Policy Changes:
The study authors emphasize the need for policymakers to address these access barriers and prioritize patient well-being.
“Despite ondansetron’s decreasing costs, most Medicare Advantage and Part D prescription drug plans continue to enforce substantial utilization management, limiting patients’ timely access while increasing clinicians’ administrative burdens,” the authors wrote.”Policymakers must prioritize access to high-value medications to prevent unneeded delays and cost in care.”
Study Details:
This cross-sectional study utilized data from the Centers for Medicare & Medicaid Services database for the third quarter of 2023. Researchers analyzed 813 part D and 3,512 Medicare Advantage prescription drug plans.
Limitations:
The study relied on plan-level data, limiting insights into individual patient experiences and the real-world impact of these policies.Funding:
Two authors received support from the University of Texas Southwestern Medical Center and the national Cancer Institute. Several authors disclosed receiving grants, personal fees, and other ties with various sources.
Barriers to Affordable Nausea Relief: Study Highlights Medicare Plan Restrictions on Ondansetron Access
NewsDirectory3.com - Millions of Americans with cancer face important obstacles in accessing an affordable anti-nausea medication due to restrictive policies implemented by Medicare Advantage and Part D plans, according to a recent study published in JAMA Network Open. Ondansetron, a widely prescribed drug to prevent nausea and vomiting associated with chemotherapy, has been available as a generic since 2006. Though, the study reveals that these plans frequently employ prior authorization requirements and quantity limits for this essential medication, potentially delaying treatment and burdening both patients and healthcare providers with administrative complexities.
Key Findings:
Prior Authorization Hurdles: Medicare Advantage plans were found to be considerably more likely (90.3%) to require prior authorization for ondansetron compared to Part D plans (71.9%).
Quantity Limits Imposed: Medicare Advantage plans also implemented quantity limits on ondansetron prescriptions more frequently (22.5%) than Part D plans (16.5%).
* Cost Discrepancies: While Medicare Advantage plans offered slightly lower costs for 4-mg and 8-mg ondansetron tablets compared to Part D plans, both plan types charged considerably more than the Mark cuban Cost Plus Drug Company, a direct-to-consumer pharmacy known for its transparent pricing. For example, a 30-day supply of 4-mg ondansetron tablets cost $24.40 in Medicare Advantage plans and $31.40 in Part D plans, compared to only $9.50 through the Cost Plus Drug Company.
The study, which analyzed data from over 4,300 Medicare prescription drug plans, emphasizes the urgent need for policy changes to address these access barriers and prioritize patient well-being.
“Despite ondansetron’s decreasing costs, most Medicare Advantage and Part D prescription drug plans continue to enforce substantial utilization management, limiting patients’ timely access while increasing clinicians’ administrative burdens,” the study authors wrote.
“Policymakers must prioritize access to high-value medications to prevent unneeded delays and cost in care.”